The Way Home

Bethesda Cares takes the most vulnerable street people and gives them a place of their own. It's a surprisingly successful approach to ending chronic homelessness. A U.S. Army vet named Chris Page would demonstrate just how critical that help can be.

By Amy Reinink

| Published: 2013-02-22 07:28

When John Mendez first saw him on that summer day in 2011, Chris Pagewas sleeping between some bushes near Wisconsin and Cordell avenues in Bethesda, less than a half mile from the trendy shops and restaurants of Bethesda Row.

As was his habit upon encountering homeless people, Mendez asked the 33-year-old if he wanted some clean socks or food. He was going to suggest that Page come to Bethesda Cares, the nonprofit homeless advocacy organization where Mendez served as an outreach worker. But before he could do so, Page took off, walking down Wisconsin Avenue.

Mendez tried again a week later, and several times more in the weeks that followed, first bringing water and snacks, then coffee and hand warmers as the weather grew colder. Slowly, Page began to accept the offerings. And six months after their first encounter, he started coming into the tiny Bethesda Cares office in a parking garage off Woodmont Avenue to use the restroom or get a cup of coffee.

During one of those visits, Page went into Mendez’s office for some canned food and started talking about his life.

Originally from the West Coast, he was a U.S. Army veteran who’d been stationed at Fort Meade. Married at one point, he’d suffered from mental illness and substance abuse for years. He had been homeless for about seven years, and living on Bethesda streets for about two.

“He was very sweet, and very easygoing,” Mendez says. “Some people get combative—that wasn’t him. He was a cool operator.”

Page’s story about his military service checked out, meaning he was eligible for a federal voucher that helps provide permanent housing for chronically homeless vets. Mendez put through the paperwork, and the housing voucher arrived less than 30 days later.

In mid-May 2012, another Bethesda Cares outreach worker accompanied Page to check out the new apartment they’d found for him in Wheaton. He finally seemed like he was getting back on his feet.

It was in 1992 that a psychologist named Sam Tsemberis came up with the unusual approach to ending chronic homelessness that Mendez and Bethesda Cares would embrace roughly two decades later. Tsemberis had spent years as a member of a psychiatric outreach team working with homeless people in New York City, and had grown frustrated as he watched countless clients with mental-health or substance-abuse issues get rejected by traditional housing programs.

He proposed a simple idea: Give people an apartment first, then provide services to address underlying issues such as mental illness or substance abuse once they’re living in a stable environment. It turned the traditional model of homeless outreach on its head. Rather than issuing housing vouchers to the most stable individuals, they would help the most vulnerable—those dealing with long-term mental-health or substance-abuse issues; those suffering from diabetes or liver disease or chronic frostbite from years of sleeping on the street. In other words, the hardest cases.

Though they represented only 16 percent of all homeless people in 2012, according to the U.S. Department of Housing and Urban Development (HUD), the chronically homeless account for more than 50 percent of the services provided to the homeless, including shelter stays, hospitalizations, emergency room visits and jail time. They’re also the most likely to die at an early age. Studies show that homeless people on the street live an average of 25 years less than people with homes.

Since its inception in 1992, Tsemberis’ organization, Pathways to Housing, says it has placed more than 600 people in apartments, with an 85 percent retention rate after six months. The nonprofit, which has since expanded to other cities, including Washington, D.C., estimates that permanent supportive housing costs $57 per night, compared with $73 per night in a shelter, $164 per night in jail, $519 per night in an emergency room and $1,185 per night in a psychiatric hospital.

The housing-first philosophy has found similar success in other cities. In Colorado, the Denver Housing First Collaborative, founded in 2003, figured it was costing $15,773 a year in health care, criminal justice and shelter costs for each chronically homeless person. With the permanent supportive housing initiative, that cost was $13,400 a year, according to the Colorado Coalition for the Homeless, the lead agency of the collaborative.

Many of the cities that have adopted the housing-first philosophy have seen significant reductions in their homeless populations, including Norfolk, Va., where there was a 25 percent reduction between 2006 and 2008, according to the National Alliance to End Homelessness.

HUD, which now designates at least 30 percent of its homeless-assistance funding to permanent supportive housing, credits the practice with reducing the number of chronically homeless people from 175,914 to 107,148 nationwide since 2005.

Mendez first encountered the housing-first model at a nonprofit homeless advocacy organization in West Virginia, where he worked before coming to Bethesda Cares in 2009. Initially, he was “adamantly opposed to it,” Mendez says. “I thought the long-term, chronically homeless would take those apartments and burn them down, or that people wanted to be homeless. None of that is true.”

Bethesda Cares, which was founded in 1988 through a public-private partnership, previously had reached out to the chronically homeless through programs that offered free lunches and medical care, among other services. But when Mendez arrived in 2009, he brought a desire to provide the chronically homeless with permanent supportive housing.

In 2011, Bethesda Cares undertook its first medical-vulnerability survey as part of the 100,000 Homes Campaign, a nationwide effort to house 100,000 chronically homeless people by July 2014, with an emphasis on surveying and tracking the candidates in order to determine who should be placed in housing first.

Bethesda Cares says it has an annual budget of roughly $400,000. Its office space and utilities are donated by the county. It operates with the help of 450 volunteers who perform a wide range of services, including hitting the streets before dawn to reach out to and survey the community’s chronically homeless.

Bethesda Cares has helped to place roughly 30 chronically homeless people in permanent housing over the past two years, with a retention rate of 96 percent over 12 months, Mendez says. Roughly a third were homeless veterans, several of them previously stationed at the area’s many military installations, such as Andrews Air Force Base or Fort Meade.

As it happened, Bethesda Cares’ efforts coincided with a major policy shift in Montgomery County, where an annual one-day survey found 982 homeless people in 2012. County Councilmember George Leventhal led the push toward permanent supportive housing after hearing about the idea from the Montgomery County Coalition for the Homeless, another nonprofit that has championed the housing-first philosophy. The county started developing its housing-first philosophy in June 2008, and has been shifting its services to that model ever since.

Montgomery County, along with nearly two dozen nonprofit partners, offers about 1,750 permanent supportive housing beds (families may have more than one bed in a unit), according to Sara Black, acting chief of the county’s Special Needs Housing division. Some are in dedicated facilities such as Lasko Manor and Cordell Place, both in Bethesda; others are scattered throughout the area. The county’s 245-household Housing Initiative Program, one of several programs in the county offering permanent supportive housing to formerly homeless people, has seen a retention rate of 98 percent over 12 months, Black says.

But only 200 of the 1,750 beds are set aside for the chronically homeless. Mendez says that number is far too low and the stakes too high, and that the county needs to do more to fast-track chronically homeless people toward permanent supportive housing.

“We’re seeing a lot of permanent supportive housing being created, but we’re seeing that the clientele recommended to be placed there still” aren’t being placed there, Mendez says. “Medically vulnerable people who are struggling with mental-health issues often don’t have the wherewithal to apply for housing. If we’re not doing effective outreach that identifies these people and places them in the housing created for them, we’re not helping our community.”

Leventhal acknowledges that “there is still a tendency somewhat for social service providers to rack up favorable statistics by placing people who are easier to place—people who have already qualified for services, and the ones that have a more friendly and welcoming attitude toward landlords.”

He believes there’s a moral imperative to take care of those who are least able to care for themselves. But not everyone sees it that way.

Malcolm Gladwell addressed the dilemma in his 2006 New Yorker piece, “Million Dollar Murray,” writing: “From an economic perspective the approach makes perfect sense. But from a moral perspective it doesn’t seem fair. Thousands of people in the Denver area no doubt live day to day, work two or three jobs, and are eminently deserving of a helping hand—and no one offers them the key to a new apartment. Yet that’s just what the guy screaming obscenities and swigging Dr. Tich gets.”